Street Medicine Symposium

7th Annual International Street Medicine Symposium

by Lauren Fryling

October 5th through 7th marked the 7th annual International Street Medicine Symposium. It was held in Philadelphia and brought together 120 individuals from street medicine teams in India, Russia, Denmark, Great Britain, Canada, the United States, and Nigeria. Thirteen members of Doctors Without Walls attended this symposium. While there, we had a wonderful tour of the city lead by Philadelphia native and MRC coordinator Rick Hovsepian. We also took time to grab a cheese steak and admire our nation’s historic sights such as the Liberty Bell, Independence Hall, and the steps where Rocky was filmed. Most importantly this trip was an amazing opportunity to learn from street medicine programs all over the world.

In addition to hearing from top authorities on street medicine, we had the opportunity to visit many of Philadelphia’s programs dedicated to helping the homeless. The first sight we visited was called Pathways to Housing, an organization dedicated to housing individuals using the Housing First model which provides immediate access to permanent independent apartments, without preconditions We also visited Women’s Space, a rehabilitation house for chronically homeless women, and St. Columbia, for chronically homeless men. These faculties were extremely impressive; they included private bedrooms and showers, as well as individualized approaches to help patients with substance abuse or mental illness.

The conference started with opening remarks from Jim Withers, founder of Operation Safety Net. He said that this conference is an opportunity to come together to share in our commonalities, because people have enough value for us to find a solution.

While listening to the amazing speakers during the symposiums 3-day program, we became increasingly aware of these commonalities that are present throughout street medicine groups everywhere. Though programs differ in size, funding, and location, each group faces similar obstacles. One of our major goals for attending the symposium was to learn from the solutions and innovations being put into practice by other street medicine organizations around the world.

It became almost immediately apparent to us that there are very similar medical issues affecting all homeless populations, regardless of location. Chronic homelessness is characterized by a tri-morbidity of mental illness, substance abuse, and chronic disease. Mental illness is a particularly difficult obstacle to tackle in street medicine because of the high cost of psychotropic medications, difficulty building trust with patients who may be paranoid or reclusive, and medication noncompliance due to theft and limited access. When addressing this issue, Tim Robinson from London emphasized the importance of building long-term relationships with patients, especially in the context of substance abuse and addiction. Not only is this a dangerous set of conditions, but also, as Robinson pointed out, “it causes stereotypes and stigmas.” To address substance abuse issues, many outreach groups emphasize their philosophy of “meeting people where they are,” whether that entails prescribing controversial drugs like methadone, or providing housing without a requirement of sobriety, such as the Philadelphia institution Pathways to Housing.

Another common obstacle to providing adequate care for the homeless is the stigmas and attitudes towards the homeless held by many traditional medical and governmental institutions. Nigel Hewett, expert advisor for The Faculty for Homeless Care in London, said, “People go into health care filled with compassion and the desire to help people. This slowly dies with social stigmas. These programs [street medicine] reawaked why people got into medicine in the first place.” A general strategy for refocusing those attitudes calls for data collection and advocacy. Dr. Hewitt, in his presentation, displayed statistics and charts he had created to show the impact of street medicine. He collected data from the hospitals in London, and was able to show that homeless outreach programs had cut the duration of hospital admissions (or, “total bed days”) for homeless individuals by one third, over the course of just three years. That reduction in admission time translated into financial savings for all the local hospitals.

Jane Isaacs Lowe, senior program officer at the Robert Wood Johnson Foundation, stressed the importance of story telling to make connections and humanize the population. Jim Withers said, “What we do is provocative, it provokes a reaction because it is not universally accepted. We have an inspirational role.”

Homelessness is not an easy problem to solve anywhere in the world. Local programs in Philadelphia seemed to be successful because they stressed a unique, personalized solution. When the current plan does not help the people it was designed to help, something else must be done. In some cases, this means bending rules and working around the established procedures. A social worker from St. Columba told us, “the protocols are written in black and white, so that we can work in the gray.” As she explained, homelessness is a very complex issue and every individual is unique, thus strict rules and protocols are not a practical solution. Just like Rosa Parks or Gandhi, defiant acts are sometimes necessary to enact social change.

This point was well illustrated by one story shared at the symposium, about a doctor who was hired to provide healthcare to a very poor community. He was given funding for medication, but when he saw how malnourished these individuals were he instead used the funding to buy them food. When the government organization found out about this, they sent an official to reprimand him. When he was asked why he was spending the funding on food instead of medication he replied, “The last time I looked in my textbooks, the specific therapy for malnutrition is food.” With that, the government official had nothing to say and left him to carry on his work.

The final theme shared among all the street medicine groups present at the conference was the need for education — both education of the general public, and education of the next generation of healthcare professionals. Mary Linda Andrews, the Director of Community Partnerships for GlaxoSmithKline, said, “Educating the next generation about homeless medicine can’t be done in an academic way. It must be experienced. They must learn by exposure to commonalities and be taken out of their comfort zone. We must lead by example.”

It was in that spirit of education that our Santa Barbara team truly stood out at October’s symposium. Many individuals remarked that they were very impressed by the level of student involvement in Doctors Without Walls – Santa Barbara Street Medicine. We had the largest representation of any group in attendance, with a total of 13 members present — 8 of whom were students or recent graduates. Several speakers called us the future of street medicine. One of the most striking images at the meeting was that of our own student volunteers seated next to the pioneers of street medicine. It profoundly illustrated the true value of one of our most abundant resources in Santa Barbara: students. As young adults aspiring to future careers in healthcare, there is no greater source of encouragement than being reminded that we have a seat at the table today. All of us returned home from Philadelphia with a renewed sense that our energy and fresh eyes are just as vital to the street medicine movement as the professional degrees held by our seasoned mentors.